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Act Fast! Only a Few Seats Available for Spring 2025 Registration!

Alleghany Jam

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Summer Camp Registration

July 15^th - 19^th, 2024 Monday to Thursday at the AJAM house and at the Alleghany Fairgrounds on the 15th.

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"*" indicates required fields

Parent/Guardian Information

Parent Name*

First Last

Email*

Phone*

City*

State*

Zip*

Okay to take photos of child participating in camp activities for use in marketing, social media, etc?

Yes

No

How many children do you want to register?

Child One Information

Summer Class Registration For?

Full: $175

Reduced: $100

Child's Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Instrument Choice

Instrument Level

Health Issues

Child Two Information

Summer Class Registration For?

Full: $175

Reduced: $100

Child's Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Instrument Choice

Instrument Level

Health Issues

Child Three Information

Summer Class Registration For?

Full: $175

Reduced: $100

Child's Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Instrument Choice

Instrument Level

Health Issues

Child Four Information

Summer Class Registration For?

Full: $175

Reduced: $100

Child's Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Instrument Choice

Instrument Level

Health Issues

In Case of Emergency

Emergency Contact Name*

First Last

Emergency Contact Relationship*

Emergency Phone Number*

Emergency Phone Number is*

Payment Option

Total

How would you like to pay?*

Pay later using Cash or check (due on first day)

Credit Card

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

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Alleghany JAM

P.O. Box 1326, 360 N. Main Street
Sparta, NC 28675

Email: alleghanyjaminfo@gmail.com

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